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Dr_Anderson, Doctor

Category: Mental Health

Satisfied Customers: 335

Experience: Psychiatrist

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I ve been taking ativan for 1 month. the dosage every 6 hrs

Customer Question

I ve been taking ativan for 1 month. the dosage every 6 hrs (set by alarm) .50mg. meds taken-7am /1pm/7pm/1amI contacted my doctor after I told him these bp/pulses & he said ok to reduce the 1pm pill to .25mg.My question since i can't reach him, in your expert opinion, can I also reduce the 7pm pill to .25mg ( I am asking is it ok to decrease from 2mg in 24hr period to 1.5mg. READINGS after 1/2 pill (.25mg) 1pm 111/93 p55, 3pm 107/83 p78, 4:30pm 117/87 p61 should I take .50 mg at 7pm or .25mg

Greetings, and thank you for your question! I see you are offline right now but will try to provide you with some information from which to start. First off, for most people Ativan does not alter blood pressure directly. It works on the GABA system in the brain, and the blood pressure systems are different (NE and EP, to be specific). Now, Ativan can relieve anxiety, as you have found out, and that lowered anxiety can translate to lowered blood pressure, but it ought not mean blood pressure that is too low. Typically, Ativan slows breathing rate and effort rather than blood pressure.

You can certainly wean off the Ativan, but given the length of time you have been off it, I'd do this under guidance of a physician. However, cutting out 0.25 - 0.5 mg at a time, or just spacing out the time between doses (which is effectively the same as not taking as much) is a very safe plan to avoid rebound anxiety and withdrawal symptoms.

For question 3, exercise in the long run usually lowers blood pressure (or keeps it close to normal), but during the actual exercise itself and for a short recovery period after the blood pressure and heart rate will be elevated - this is normal and desired.

Hope this gets you started! Please let m know if you have further questions or if I may be of further service!

For most people, a pulse of 55 is not worrisome. As long as you are not having any symptoms, such as shortness of breath, chest pain, or dizziness, a pulse of 55 should be fine. In fact, many people who exercise have their pulses routinely in the 40's to 50's. So, to have it at that rate, as long as you feel fine, is probably ok.

Greetings, and thank you for the follow-on questions. Let me answer each in turn:

(1) Hard to say, because it could be either or both! Although I'm more inclined to cite the Ativan withdrawal as the culprit. Why? It came on very suddenly, from how you describe it. If it were your thyroid, it would be a bit more insidious in onset. Still, it is good to get the TSH, free T4, and T3 rechecked to be on the safe side.

(2) Ativan will not hurt you if you are hypothyroid, although fatigue induced by it may look like hypothyroidism. Ativan, per se, does not have an impact directly either way.

(3) Levothyroxine can do either, depending upon the dose and clinical situation. For example, in a normal thyroid, if a large dose of levothyroxine is given, it may induce anxiety because it mimics hyperthyroidism. But, in a person who is anxious or depressed, a low dose of the medication may lead to improvement of symptoms, whether or not the thyroid is hypo. (Of course, if a person is hyperthyroid, levothyroxine will make a person feel worse!).

Glad to be of service, I hope this helps out. Please let me know if I may be of further service!

Yes, it is possible to get muscle aches, including chest pains. Those could also be rebound anxiety symptoms.

Magnesium can be helpful. So does making sure your potassium intake and phosphorous are ok. For some of my patients, they try an herbal, Calms Forte, to assist with the anxiety symptoms, although the results have been mixed at best.

(1) Typically, lowering of Ativan will lead to elevated blood pressure readings if there is rebound or withdrawal symptoms, so you ought to be able to cut another dose now.(2) Blood pressure and pulse go up if it is rebound anxiety or withdrawal symptoms, true. With the pulse being good, this tells me you are having neither, so further cuts can safely and comfortably be made.(3) Typically, low blood pressure is not due to cutting back, although dizziness can be a withdrawal symptom. I think, though, that some of the blood pressure issues (and dizziness as a result of that) are something else (vasovagal response and dehydration are two common causes, as well as blood pressure medicines or other medicines that lower blood pressure as another common cause).(4) which is listed as (5) Normal SBP and pulse, DBP normal high.(5) which is listed as (6) Cutting down a week later is ok, given you are not having withdrawal or rebound problems. You can go sooner than that, but going down weekly gives you some predictability in the taper off. It shouldn't shock your system, since it is on a controlled schedule of removal.(6) which is listed as (7) Depends. Usually the very last bit (0.25 - 0.5 mg) is the hardest to come off of, if there is any difficulty art all.

Glad to be of help! This is a tough time for you, so I'm glad to be of service.

Typically, withdrawal symptoms peak at the 3-5 day mark, but they may be present for as late as 2 weeks following a dose decrease. I encourage people to journal their symptoms, this way they can tell if they are feeling better or worse day by day. Sometimes a person may feel badly, only to note that how they feel is still better than the day before!

Given the various aches and pains you have, I'd hold on your current dose until they resolve or at least feel better before cutting back again. I think you are "in the thick of it" right now, although you ought to feel better over the next few days.

QUESTION 1- Any other suggestions? The thought of this for the next 2 months is really bothering me.

Remember, that is a WORST case scenario, not the typical or best case one! Think optimistically, that you will be a typical or best case. Keep in mind that this has an end, and you will feel better on the other side of this rigamarole.

QUESTION 2 - Plse tell me the truth is 2mg per day considered a average or high dose? I took that for 4 weeks and now am at 1.75mg.

2 mg per day is average, I have seen folks on far higher doses before.

QUESTION 3 Does it get easier for people at all?

Yes! But the stormy waters are something that have to be passed through. BUT...you WILL pass through them! Anxiety is horrid, but it will not kill you. It is uncomfortable, yes, but treat it like a very protracted toothache or childbirth.

QUESTION 4 Will adding salt to my diet prevent dehydration?

No, but keeping up with your water intake will.

You are welcome! Please let me know if you have any further questions, and please leave feedback about our time together! Regards, XXXXX

I will tell you that...the things you have to go through to be an Expert are quite rigorous.

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